Welcome Back And Why Postpartum Matters

SPEAKER_02 0:11

Hey guys, welcome back, Preview Alliance. Sarah and Whitney here. And again, we had such an awesome conversation with Emily about what to do in pregnancy with pelvic floor. We brought her back for postpartum series. That's right. Emily, thank you again. Yay. So happy to have you. So tell us all things postpartum. What do you think? What do women need to know?

SPEAKER_01 0:32

All right. First of all, this is my biggest soapbox. Okay, we love it. Because this is this is an orthopedic issue, right? And we treat our ankle sprains better than we treat our postpartum moms, right? Sophie. We do. It's ridiculous. If you have a you know a standard knee surgery, somebody's gonna be seen at two weeks, at six weeks for progression of rehab, at 12 weeks for return to sport. If you have a postpartum mom, they're like, um, we see you in the hospital, we see you at six weeks. See ya. See you in a year for your age. And then nobody asks, like, how did that go? Yeah, yeah. Like, go resume everything, and then nobody's checking to be like, did that go okay for you? Did you have any issues? Right. And I think um societally it's kind of expected that women are gonna have issues. Yeah. And so, like, we get the lines get blurred between what is normal and what is typical. So it's kind of expected, like, oh, you had a baby, like, of course you can't run without peeing your pants, or like uh sex is gonna hurt. You had a baby, what did you expect? Right, right. But and those issues are typical because our postpartum care in this country is abysmal, but they are not normal. Yeah, but they can be treated.

SPEAKER_00 1:34

Yeah, there's a difference between common and normal. Exactly.

SPEAKER_01 1:38

So, like, what is

Common Is Not Normal Postpartum

SPEAKER_01 1:40

typical doesn't have to be tolerated. Oh, I love it. I that's right, yes. So, like, you know, we see a multitude of issues, and we're gonna kind of cover some vaginal and cesarean birth issues.

Painful Sex Scar Tissue And Dryness

SPEAKER_01 1:51

So, some kind of heavy issues that we hit um in the postpartum period is um issues with intercourse, right? So sometimes it's very painful, right? And that can be to the extent that it just cannot be done. And so, like, we'll see this a little bit more with um our vaginal births, right? So, like sometimes there's tearing that occurs during birth. And God love you, mamas that have a fourth degree. Bless it, right? Yeah, yeah. If you have a fourth degree and your your provider has not um suggested therapy, like please reach out, find somebody, even if you don't have one in your area, people do virtual visits and they could probably cool, you know, help you because that's you know very extensive. Yeah, that's a full thickness muscle tear. Yeah, you know, um, so we can have tearing and scar tissue fills into those tears, and scar tissue is a normal art of healing, but scar tissue has to move. So if scar tissue doesn't learn, hey, I need to move with these muscles as they're being stretched or contracted, the scar tissue can be a big limiter. So people, you know, they're told at six weeks, like, all right, you're good to resume intercourse.

SPEAKER_02 2:49

And they're shocked when they're like, oh my gosh, this feels freaking and then that's a whole mental health issue, partnership issue, self-confidence. Oh, yeah.

SPEAKER_01 2:58

And there's a multitude of factors that impact that. Yeah. I mean, breast breastfeeding, if you're if you're breastfeeding, you know, can make vaginal tissues very dry. Yeah. So we can have a lubrication issue. And so usually that's the blanket advice is just like use tons of lube or drink wine. Oh, don't even get me started on that nugget of terrible advice.

SPEAKER_02 3:16

I've heard that. Just relax, drink wine.

SPEAKER_01 3:18

Well, I I think a lot of times it's assumed that it's a lubrication issue, and that can be the case, but then people are like, I use tons of lube and I still felt horrible. Yeah. And to me, I'm like, all right, then we probably have like a scar tissue or muscle issue where they're stretching, yeah, and they aren't. Yeah. So let's stretch them and they don't necessarily need moisture, they just mobility. Yeah, yeah, right. And the drink, wine, and relax really ticks me off.

SPEAKER_00 3:38

It's because like basically just go get tipsy and have sex. Like that doesn't actually solve the issue.

SPEAKER_01 3:43

Like it's still gonna hurt. And that and also like some people don't drink. Yeah, yeah, right? Or like some people take medications where they can't drink or choose not to. Yeah. And some people, you know, maybe can't have a glass of wine in the morning. Yeah. That's their time. Yeah. Like to connect, and I just think it's the worst. And then if they do that and it doesn't help, then they're just like, that was the only solution I was given. And I think that's to sit here and live this.

SPEAKER_02 4:06

So sex is not have to hurt post baby. So let's make that statement. Yeah. And if it is, we need to reach out.

SPEAKER_01 4:14

So we can have we can have two issues, right? The first one is like we we have issues with penetration, so either we can't achieve it or it's painful, yeah, or we can have issues with deep maybe insertion is not the problem, but deep penetration is, or there can be um an inability to have orgasm or pain with that as well. So um those can be treated.

SPEAKER_02 4:36

Okay.

SPEAKER_01 4:36

You can do a lot of positional modifications, you can work on the scar tissue, you can help with the mobility of the pelvic floor, and a lot of times that gets significantly better. I also think it's important to note that research is showing a lot of the problems that we see postpartum, which are pain with sex, incontinence, or like leaking urine or poop or gas. Um, if they're still present in 12 weeks, they're likely to be there at a year.

SPEAKER_02 5:01

Okay.

SPEAKER_00 5:01

So that's a big difference from three to 12 months.

SPEAKER_01 5:05

Yeah. So, you know, some people are just told to wait. Like, wait four months, wait six months. I'm like, no, if it's there at 12 weeks, it is likely to be there in a year.

SPEAKER_02 5:12

Similar postpartum depression anxiety, like it doesn't just go away. Right.

SPEAKER_01 5:16

And so don't just wait it out. Yeah. Right. And so and people that have a cesarean birth are often shocked because they're like, my vagina is supposed to be spared. Yeah. I didn't give birth that way, but a lot of times I felt the same way. I felt that. I remember saying that. I'm like, why is this happening? And a lot of times they're they're really shocked because they're like, I'm not supposed to have visa issues. I'm just supposed to be dealing with the weak core or my abdominal or whatever. But especially the the ones that labored for a while and then they ended up having, you know, a more S-section that was unplanned or emergent. Like their pelvic floor got all those contractions with referrals from the contraction and didn't get any of the stretch of birth. So a lot of times it is tighter postpartum, so they can have issues as well. And they're like, I'm not even supposed to have this. But they do.

SPEAKER_00 6:03

So and that's the thing, our bodies are just connected to every other part of our body, right?

SPEAKER_01 6:09

Yeah, and and there's something to speak to birth trauma as well. Well, yes, yes, you know, because birth trauma, I mean, that's real. And I trauma manifests in our tissues, and birth trauma, I think, sometimes is blown off of like you're healthy, your baby's healthy. What is the problem? Gaslighting, yes. Yeah, and the body keeps the same. And the body is like, no, something terrible happened, and we're gonna fort nox it down here so it never happens again back then.

SPEAKER_02 6:33

I mean, that happened, I mean, it happened to me with our oldest. I mean, very traumatic C-section, and I had urinary pains. Yeah, and I remember going to the back and saying, This is not right. And then I actually did um EMDR therapy for my birth trauma. Good for you. And I released that and it got better. No, that I was holding it there, back pain, whatever that happens. So that's very important to know is that our birth experience is gonna come like like you said, it holds in there. It does. And so we need to, and sometimes you turn to OBs, you turn to your friends or your family, and you're like, they're like, we just had a baby, right? Like, this is to be expected. So these pains, these hurts, moms listening, voice them. If you're not hearing it, if you're not getting what you need for maybe OBs for support, search out pelvic flora therapist. And our first episode of pregnancy, Emily broke down like how to find um someone who's certified there. And she talked all about the pelvic floor. So please refer back to that one, and we'll link some notes too, but you peeing on

Leaking Urine The Knack And Coordination

SPEAKER_02 7:35

ourselves. Let's let's just let's just bring that up. Let's just get it out. Yeah. Are we supposed to?

SPEAKER_01 7:39

Absolutely not. Okay, because that's that is typical. Motherhood does not mean you pee yourself.

SPEAKER_02 7:45

Because that's like an ongoing thing. Like, oh, you had a baby now, you pee your baby.

SPEAKER_01 7:48

And the worst the worst part is like some fitness industries encourage it. No, they do. But they do, they'll be like, ladies, it's a plyo day, wear your pad. And I'll be like, no, you are encouraging and enabling public flickers and detection and weakness and poor, you know, coordination. So no, we should not. And that's one of those things that people are told to wait, or it's told to be expected. But again, research shows if you're having incontinence at 12 weeks, you are likely to have it at a year. So, what can we do for that? So it kind of depends because sometimes we can have one of two issues. Sometimes people can leak because they're on that tight side, and sometimes we're weak.

SPEAKER_02 8:24

Yeah, just like you know, it's probably hard to tell that as like the patient, the patient. Right.

SPEAKER_01 8:28

You need and sometimes we can have a nice little combo. So that's why like getting um evaluated is important. Absolutely. But I think um that responds really well to treatment, and again, it's just that a lot of times after birth, that disruption of like our brain and our muscles, and we tell it where to go, it just gets interrupted. We think we're doing something, but we're not. Yeah, and and normally, like before we had babies, we would get this reflexive contraction called the knack. So, right before we cough, sneeze, we would get this like little pelvic floor contraction a millisecond before that, and we would stop, sneeze, and that's why we never think about that. Yeah. When we're 20. Yeah, right, pre-kids. But that gets disrupted when we have a baby. Oh, wow. Because we get a massive stretch of those areas, and then sometimes they're like, I forgot how to contract. You have to teach it, or I'm not contracting at the right time, right? And so some people will think I'm we could contract post-sneeze instead of pre-sneeze, right? Or some people will think, I I'm doing that, or you know, I'll watch them cough or sneeze, and they're actually like moving the opposite way. They're actually like opening the door.

SPEAKER_00 9:33

That is the opposite of what we're going for.

SPEAKER_01 9:35

We just have to kind of like grade it, find out what they can do, and build up from there. Because sometimes it's coordination, like we're just totally moving in the opposite direction. Sometimes it's endurance of like we can move that way for five, but then by seven, we're fatiguing and we're leaking. So then that's kind of like gradually just like building up muscle strength anywhere else. We need power strength, endurance, good coordination.

SPEAKER_00 9:55

Probably consistency too with the exercises. Right.

SPEAKER_01 9:59

So, again, like um, research has shown incontinent women typically have poor coordination and use the wrong muscles at the wrong time. So, again, we could be kiggling at the stoplight. What we think is that, but chances are we're probably not doing it right if we're still like making a problem worse. Well, we just might not be like helping it if we're just doing it wrong. A lot of people a lot of people will, you know, just squeeze with their inner thigh or squeeze their butt or clinch their butt all day, but that's you know, just giving the felic floor a free pass to sleep with a wheel. And so, like, listen to me when I say too, we should be able to sneeze without crossing our legs.

SPEAKER_02 10:31

Okay, take note. Yep, there you go. Sex should not be painful, we should not be peeing on ourselves when we're sneezing. We don't have to cross our legs. Thanks, right. Um what about the mommy pooch?

C-Section Scar Mobility And The Shelf

SPEAKER_01 10:44

Are you talking about like after a C sex? Yes, because I'm like, is this my life now? Right. So one thing, excuse me, one thing that they really don't talk about a lot is that we need that scar mobility after a cesarean birth, right? And like that poor abdominal wall stretched and yanked and sewn back together. Yeah. And then we see these scars that kind of dive in like a cavern.

SPEAKER_02 11:05

Yeah, that's how mine is.

SPEAKER_01 11:06

And then people are like, what is this shelf? But nobody's ever told to move their scar. But those scars, just like perineal scars, need to be able to move with the tissues back and forth. Um, and so those areas can get really adhered and really tight, and not to mention, like immediately with cesarean recovery, people are often kind of punched over their scar. It hurts. Yeah, it does. They have trouble getting upright, and that kind of like little forward flex posture causes everything in the front of the hip and that lower abdominal wall to be tight. So I usually tell people like, you know, we want to wait six to eight weeks and we need skin integrity to be great. We don't need any open areas, we don't need any scabs, we need nothing. So really needed to have started to grow back together. Right. We need it to be totally healed. But even those first few weeks, some people don't even want to look at their scar. It can be associated with trauma. I was about to say it can be associated with a lot of things, and they they don't want to look at it. I felt that way. They're scared to touch it.

SPEAKER_00 11:58

What do you feel like that's heightened when someone has a classical incision transverse? So the up-down versus like a cross. Uh absolutely because the up downs. Because that is like emergent, emergent life or death. Yeah, you really don't see those very often. Um I was very lucky I got it. Once in my seven years at St. Vincent, yeah. Very often.

SPEAKER_01 12:20

And I would say yes, and that that is I mean, very disruptive to the functioning of the abdominal wall, just as a as a muscle.

SPEAKER_02 12:28

Even if they're cutting, like they went the same incision on both my deliveries. So I felt like it got worse after my second.

SPEAKER_01 12:36

Well, and my and that's probably because that scar tissue wasn't mobilized after the first. Okay. Right. And so, like, some easy things I would say at first, I would say just start looking. Okay. And then like those first few weeks and like light skin touch, just like kind of being familiar with it. Because like that, you know, they cut those tissues and those, you know, sensory nerves are disrupted. It feels numb. It feels weird. And we have to kind of retrain our brain from a sensory perspective of like this is this light touch, brain. This does not hurt. Yeah. Like, we have to retrain those nerves, right? And so, like, oftentimes touching an intact sensory area, like the side of your arm is you're kind of like lightly brushing those lower abdomen around your scar, even if we're we have serious chips on, we can't touch our scar, even those neighboring tissue. Starting with some gentle kind of back mobility stuff, some child's pose, some cat cow, some gentle hip flexor stretching can help that area. But the first few weeks, the the most crucial thing is the protection of this this because like having an incision open back up and getting infected and stuff can set you back, and and that again is really disruptive.

SPEAKER_02 13:43

I think that's harder too if you have an older child.

SPEAKER_01 13:45

Yeah. Oh, for sure.

SPEAKER_02 13:47

Because I remember Will running to me and I heard I felt it, and I was like, oh my gosh, did this just rip up? And it didn't, but it was just that fear, and then you're just like, I don't want to go.

SPEAKER_01 13:55

One thing, and you know, they say like, don't pick up your kid, but how can you like you have a toddler and they're screaming for you, or they just fell and they got hurt.

SPEAKER_02 14:03

Getting your kid in, I mean, if you have a large child plus a car seat, yeah, and it's just you, how are you gonna get it?

SPEAKER_01 14:08

Yeah, and I think too, like we could also do a much better job of like helping moms with birds in the hospital. Thank you. Can I just say that that is the only abdominal surgery not seen in the hospital by a physical therapist? Uh well, yeah. Like if you have other abdominal surgeries, like they take a part of your colon out, a physical therapist comes to your room and they're like, Let me tell you how to get out of bed, let's walk down the hallway. But like so you got PT or OT coming to you to help out.

SPEAKER_02 14:30

And then with moms, they're like, here you go, good help. Here's the screaming baby. Good luck. Your abdomen's been ripped open, yeah, things have been moved around. The good luck. So even more, probably I mean, not to discredit our vaginal birth mommies, but C-section mommies, like, you probably needed a little bit more CLC. Especially, you know, immediately.

SPEAKER_01 14:47

Yeah. Yeah. Right? Like, because you know, I I mean, from what I've heard, I mean, I had vaginal births, but from what I heard, you know, people come in and be like, all right, it's time to get up. And they're like, What? Yeah, I can't imagine getting up right now. My ab is killing me. I'm having pain. And even something as simple as like, hey, we're gonna log roll and then need you to exhale, right? Before you do that. Because they don't tell you that it's helpful. They don't tell you that. Because then we aren't like holding our breath and putting it, pushing out against our abdomen, like getting those legs off the bed first and using your arms to push up so we aren't coming from like a full body crunch to try to sit up is really helpful.

SPEAKER_00 15:22

Kind of like what you mentioned in that previous episode with the lightning crutch kind of thing. It's like take your movement in stages, don't do the quick motion because that's going to hurt and exhaling during those transitions of just like gentle exhale.

SPEAKER_01 15:35

So we aren't like holding our breath and doing like a valsalva when we're trying to transition, and then you know, kind of getting those upright postures a little faster. And that's where like that abdominal binder in the hospital can come in. Yeah, because then we have compression and we have support over that area. Um, and then you know, we're told nothing to do with our scar, and then you get you go back in the six or eight weeks, and then they're like, Oh, oh, good. Everything's healed, go back to what you want. But um, you know, that abdominal wall needs re-education. Yeah, just like any other area of the body that would be. I mean, if you have a rotator cuff repair, you have therapy for 12 weeks, no questions. Yeah. But then people are like, Oh, I hate the way my stomach looks. I'm just gonna start doing all this ab stuff. But a lot of times they're kind of doing maybe not the most appropriate activities for that stage that they're at, and they just end up feeling all their ab work in their back or using their hip flexors, and we're not really getting the abs. Yeah, um, diastis recti can be an issue with both vaginal or cesarean birth.

SPEAKER_02 16:34

And that's basically where it stays out.

SPEAKER_01 16:36

Yeah, yeah, and and it's not ripped, which I think is an important thing to note because people will be like, my abs ripped during pregnancy. And I'm like, they're not ripped, it's the midline is thinned and it's stretched, you know, but like you aren't broken. Yeah, yeah. You just need like appropriate exercises, and they're a little bit more um typical after a cesarean birth. Okay. And so then, like, once the incision is totally healed, then we can start with some scar mobility so we get that area moving so they don't try to do exercise and feel incision pain, which can still be happening at like eight, nine, ten minutes postpartum.

Six Weeks Starts Rehab Return After 12

SPEAKER_01 17:08

Absolutely. And I mean, for both, like, if if we talk about like kind of general guidelines for postpartum recovery, I think six weeks to me means we start rehab and we don't talk about return to sport till after 12 weeks.

SPEAKER_02 17:22

Okay, good. Appropriate. Take that in.

SPEAKER_01 17:24

So, like that that like six weeks is the time when we start corrective exercises and we're talking about cleaning up.

SPEAKER_00 17:30

We started imbalanced healing. Yeah, we're gonna do that. We worked on our healing in the first six weeks, and now we can start working on repair.

SPEAKER_01 17:36

Right. And so, like, you know, I hate six weeks. All right, go, yeah, can I run? Yeah. And I'm like, well, running is a single leg activity where we're just hopping from one leg to another, and I almost never recommend running before 12 weeks post-party.

SPEAKER_02 17:48

Okay, good to know.

SPEAKER_01 17:49

There, that's because I'm like, everything from six to 12 weeks should be like we're cleaning up all this weakness and imbalance that occurred during pregnancy. And then we are gonna be make sure that when you get back get ready to return to run, that it's successful. Exactly. And we aren't just like hit the pavement, PR pins. Yeah, hit the pavement. Now I have plantar fasciitis, yeah, or I do band stuff that like we've restored core strength and trunk strength, and that those return to sports successful. Yeah. And again, you talk about mental health. Yeah, I mean, I think this this phase can be really difficult for women because they're like, I want to bounce back. I use exercise to cope, or like this is is this what my body is gonna look like? Forever. And they try to do stuff, you know, but nobody gives us guidance on like where to start or what exercises are more appropriate. And so it's frustrating. And then they they try to do something that makes them feel better, it doesn't work out the way that they want, and then now we've stripped away another maybe coping mechanism that can help with depression or anxiety.

SPEAKER_00 18:47

Absolutely, and they feel like their body's failing them. Well, and then you see so many celebrities and things like that where they're, you know, four weeks postpartum and either they've lost all the baby weight or they're getting back to exercise. And it's like, I'm over here running on two hours of sleep, barely keeping my head above water.

SPEAKER_02 19:01

Just being realistic, what they I guarantee they have this education. I guarantee you their personal trainers or their do-lists are they are working with them, doing these activities during pregnancy and postpartum. So, yes, it's a disadvantage, but we're here to educate you guys, but it's all as much on the level fill because moms deserve, no matter where you are in life. Yeah, you deserve this education.

SPEAKER_01 19:18

And there are some like, you know, pretty good like online guides as far as um some like postpartum progressions. We have like an early postpartum series on our Instagram page. We'll link that really helpful for the first six weeks of just like getting those abs engaged, working on diaphragmatic breathing, helping the diaphragm, the abs, the pelvic floor all start to row in the same direction and help each other.

SPEAKER_02 19:38

I love it.

SPEAKER_01 19:39

Um, so you can start kind of establishing that reconnection with your body. So, I mean, like my goal, hopefully in my life before I die, is that like postpartum rehab would be the standard of care. And that's where we come from.

SPEAKER_02 19:51

We love parting with you because of this because our goal is for screenings and therapy and education for the maternal mental health side.

SPEAKER_00 19:59

But you know giving mom resources.

SPEAKER_02 20:01

That's what our whole goal was. I guess we'll leave on this question.

It Is Never Too Late To Treat

SPEAKER_02 20:04

Is it ever too late? It is never too late.

SPEAKER_00 20:06

Like once postpartum, always postpartum. What if I'm like 20 years postpartum? My kid is off to college, but I'm still peeing myself. No problem. I had a patient like that one time. Really?

SPEAKER_01 20:15

22 years postpartum. Wow. Stress incontinence. It was a simple coronation issue, gone on three visits.

SPEAKER_00 20:20

Oh my god. You're kidding me. So she was like poor. I might be my kid for 20 years. She has suffered for two.

SPEAKER_01 20:27

It's never too late. Even like, um, it's easier just from a tissue quality perspective, if we're like before menopause. Yeah. Even post-menopausal, the pelvic floor can be treated. And sometimes these unresolved issues postpartum, you know, come back. Yeah. Yeah.

SPEAKER_00 20:44

And probably because the hormones have an influence on that. Everything's right. Yep.

SPEAKER_01 20:47

And so, like, yeah, and so sometimes these unresolved issues postpartum are like the incomplete healing or compensate till we lose the hormonal advantage of menopause.

SPEAKER_00 20:57

And it's never too late then. You can get it then too. So, mom is it's never too late to get the help you need.

SPEAKER_02 21:04

And we're talking, you don't have to live with peeing yourself, painful sex, your mommy, the separation pooch here, or just feeling like something's off in my body, or advocating for yourself.

SPEAKER_01 21:18

Oh, and if you feel like something happened and I never recovered, it's something happened and you never recovered. Yeah. Yeah. Probably, you know, because it wasn't like the right tools or resources, um, which can, you know, be made available at any stage.

SPEAKER_02 21:31

You're never gonna go wrong and get it evaluated by someone.

SPEAKER_01 21:34

I I also think like, you know, mothering is a very physical activity. Yes. Kids are heavy and they want us to hold them all the time. I still give my six-year-old piggy bag rides every morning down the stairs. Even knowing the proper way to do it. So, like, strength for the maternal body is crucial. And we need that to be able to like keep up with our kids and live them appropriately and feel good mechanically. And um, you know, that's not to be discounted as well. That just the act of mothering itself is freaking physical and hard. Yeah, thanks. Amen, sister.

SPEAKER_02 22:03

Emily, your pleasure. Come back, we'll have you back and we're gonna link all these awesome resources for you. But till next time, guys.

SPEAKER_00 22:10

All right, see y'all later. See ya.

Closing And Where To Find Help

SPEAKER_02 22:13

Maternal mental health is as important as physical health. The Preview Alliance podcast was created for and by moms dealing with postpartum depression and all its variables like anxiety, anger, and even apathy. Hosted by CEO, founder Sarah Parkers, and licensed clinical social worker Whitney Gay, each episode focuses on specific issues relevant to pregnancy and postpartum. Join us and hear how other moms have overcome mental health challenges as well as access tips and suggestions on dealing with your own challenges as moms. You can also browse our podcast library and listen to previous episodes at any time. Please know you're not alone on this journey. We're here to help.